Skip to main content

Advertisement

SpringerLink
Log in

Safety and effectiveness of Thulium VapoEnucleation of the prostate (ThuVEP) in patients on anticoagulant therapy

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

To evaluate the safety and efficacy of Thulium VapoEnucleation of the prostate (ThuVEP) for patients on oral anticoagulants (OA) with symptomatic benign prostatic obstruction (BPO).

Methods

Fifty-six patients, undergoing ThuVEP at two institutions, were evaluated from May 2009 until June 2011. All patients were at high cardiopulmonary risk and presented with a median American Society of Anesthesiology score of 3 [interquartile range (IQR) 2–3]. Thirty-two patients were on aspirin, 8 were on clopidogrel or clopidogrel and aspirin, and 16 on phenprocoumon at the time of surgery. Patient demographic, perioperative, and follow-up data were analyzed.

Results

Median prostate volume was 50 (IQR 34–76) cc, and resected tissue weight was 32 (IQR 20–50) g. The median operative time was 61.5 (IQR 40–100.75) min, and the catheter time 2 (IQR 2–3) days. There were no perioperative thromboembolic events. Five patients (8.9 %) required a second-look operation in the immediate postoperative course (hemorrhage n = 4, residual adenoma n = 1) and four (7.1 %) blood transfusions. Complications within the first 30 days included urinary tract infections (1.7 %), urinary retention (3.6 %), and delayed bleeding (7.1 %). These complications were managed conservatively. At 12-month follow-up, median QoL [5 (IQR 3.75–5) vs. 1 (IQR 1–2)], IPSS [21.5 (IQR 15.5–23.75) vs. 5 (IQR 3–8)], Qmax [7.7 (IQR 6.3–10) vs. 28.3 (IQR 21.25–39.2) ml/s], and postvoiding residual urine [100 (IQR 46–200) vs. 17.5 (IQR 0–36) ml] improved significantly (p < 0.002).

Conclusions

Thulium VapoEnucleation of the prostate seems to be a safe and efficacious procedure for the treatment of symptomatic BPO in patients at high cardiopulmonary risk on OA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG, Urology Section of the Bavarian Working Group for Quality Assurance (2008) Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 180:246–249

    Article  PubMed  Google Scholar 

  2. Bell CR, Murdock PJ, Pasi KJ, Morgan RJ (1999) Thrombotic risk factors associated with transurethral prostatectomy. BJU Int 83:984–989

    Article  CAS  PubMed  Google Scholar 

  3. Van Arsdalen KN, Barnes RW, Clarke G, Smith MJ, Koontz WW Jr (1983) Deep vein thrombosis and prostatectomy. Urology 21:461–463

    Article  PubMed  Google Scholar 

  4. Parr NJ, Loh CS, Desmond AD (1989) Transurethral resection of the prostate and bladder tumor without withdrawal of warfarin therapy. Br J Urol 64:623–625

    Article  CAS  PubMed  Google Scholar 

  5. Chakravarti A, MacDermott S (1998) Transurethral resection of the prostate in the anticoagulated patient. Br J Urol 81:520–522

    Article  CAS  PubMed  Google Scholar 

  6. Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T (2005) High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol 173:158–160

    Article  PubMed  Google Scholar 

  7. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58:384–397

    Article  PubMed  Google Scholar 

  8. Elzayat E, Habib E, Elhilali M (2006) Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol 175:1428–1432

    Article  CAS  PubMed  Google Scholar 

  9. Ruszat R, Wyler S, Forster T, Reich O, Stief CG, Gasser TC, Sulser T, Bachmann A (2007) Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients with ongoing anticoagulation. Eur Urol 51:1031–1038

    Article  CAS  PubMed  Google Scholar 

  10. Bach T, Netsch C, Haecker A, Michel MS, Herrmann TR, Gross AJ (2010) Thulium:YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 28:39–43

    Article  PubMed  Google Scholar 

  11. Bach T, Netsch C, Pohlmann L, Herrmann TR, Gross AJ (2011) Thulium:YAG vapoenucleation in large volume prostates. J Urol 186:2323–2327

    Article  PubMed  Google Scholar 

  12. Descazeaud A, Robert G, Azzousi AR, Ballereau C, Lukacs B, Haillot O, Dumonceau O, Devonec M, Fourmarier M, Saussine C, de la Taille A, Committee for lower urinary tract symptoms of the French Association of Urology (2009) Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review. BJU Int 103:1162–1165

    Article  PubMed  Google Scholar 

  13. Dotan ZA, Mor Y, Leibovitch I, Varon D, Golomb J, Duvdevani M, Ramon J (2002) The efficacy and safety of perioperative low molecular weight heparin substitution in patients on chronic oral anticoagulant therapy undergoing transurethral prostatectomy for bladder outlet obstruction. J Urol 168:610–613

    Article  CAS  PubMed  Google Scholar 

  14. Taylor K, Filgate R, Guo DY, Macneil F (2011) A retrospective study to assess the morbidity associated with transurethral prostatectomy in patients on antiplatelet or anticoagulant drugs. BJU Int 108(Suppl 2):45

    Article  PubMed  Google Scholar 

  15. Raj MD, McDonald C, Brooks AJ, Drummond M, Lau HM, Patel MI, Bariol SV, Wang AC, Woo HH (2011) Stopping anticoagulation before TURP does not appear to increase perioperative cardiovascular complications. Urology 78:1380–1384

    Article  PubMed  Google Scholar 

  16. Rajbabu K, Chandrasekara SK, Barber NJ, Walsh K, Muir GH (2007) Photoselective vaporization of the prostate with the potassium-titanyl-phosphate laser in men with prostates > 100 ml. BJU Int 100:593–598

    Article  PubMed  Google Scholar 

  17. Pfitzenmaier J, Gilfrich C, Pritsch M, Herrmann D, Buse S, Haferkamp A, Djakovic N, Pahernik S, Hohenfellner M (2008) Vaporization of prostates of > or = 80 mL using a potassium-titanyl-phosphate laser: midterm-results and comparison with prostates of < 80 mL. BJU Int 102:332–337

    Article  Google Scholar 

  18. Pedraza R, Samadi A, Eshghi M (2004) Holmium laser enucleation of the prostate in critically ill patients with technique modification. J Endourol 18:795–798

    Article  PubMed  Google Scholar 

  19. Yuan J, Wang H, Wu G, Liu H, Zhang Y, Yang L (2008) Highpower (80 W) potassium titanyl phosphate laser prostatectomy in 128 high-risk patients. Postgrad Med J 84:46–49

    Article  CAS  PubMed  Google Scholar 

  20. Sandhu JS, Ng CK, Gonzalez RR, Kaplan SA, Te AE (2005) Photoselective laser vaporization prostatectomy in men receiving anticoagulants. J Endourol 19:1196–1198

    Article  PubMed  Google Scholar 

  21. Tyson MD, Lerner LB (2009) Safety of holmium laser enucleation of the prostate in anticoagulated patients. J Endourol 223:1343–1346

    Article  Google Scholar 

  22. Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE (2011) Outcomes and complications After 532 nm laser prostatectomy in anticoagulated patients with benign prostatic hyperplasia. J Urol 186:977–981

    Article  PubMed  Google Scholar 

  23. Woo HH, Hossack TA (2011) Photoselective vaporization of the prostate with the 120-W lithium triborate laser in men taking coumadin. Urology 78:142–145

    Article  PubMed  Google Scholar 

  24. Sohn JH, Choi YS, Kim SJ, Cho HJ, Hong SH, Lee JY, Hwang TK, Kim SW (2011) Effectiveness and safety of photoselective vaporization of the prostate with the 120 W HPS greenlight laser in benign prostatic hyperplasia patients taking oral anticoagulants. Korean J Urol 52:178–183

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hauser S, Rogenhofer S, Ellinger J, Strunk T, Müller SC, Fechner G (2012) Thulium laser (Revolix) vapoenucleation of the prostate is a safe procedure in patients with an increased risk of hemorrhage. Urol Int 88:390–394

    Article  PubMed  Google Scholar 

  26. Tinmouth WW, Habib E, Kim SC, Kuo RL, Paterson RF, Terry CL, Elhilali M, Lingeman JE (2005) Change in serum prostate specific antigen concentration after holmium laser enucleation of the prostate: a marker for completeness of adenoma resection? J Endourol 19:550–554

    Article  PubMed  Google Scholar 

  27. Martin AD, Nunez RN, Humphreys MR (2011) Bleeding after holmium laser enucleation of the prostate: lessons learned the hard way. BJU Int 107:433–437

    Article  PubMed  Google Scholar 

  28. Bach T, Muschter R, Sroka R, Gravas S, Skolarikos A, Herrmann TR, Bayer T, Knoll T, Abbou CC, Janetschek G, Bachmann A, Rassweiler JJ (2012) Laser treatment of benign prostatic obstruction: basics and physical differences. Eur Urol 61:317–325

    Article  PubMed  Google Scholar 

  29. Shah HN, Mahajan AP, Hegde SS, Bansal MB (2007) Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int 100:94–101

    Article  PubMed  Google Scholar 

  30. Mamoulakis C, Efthimiou I, Kazoulis S, Christoulakis I, Sofras F (2011) The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 29:205–210

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany

    Christopher Netsch, T. Bach & A. J. Gross

  2. Department of Urology, MHH Medical School of Hannover, Hannover, Germany

    M. Stoehrer, M. Brüning, A. Gabuev & T. R. W. Herrmann

  3. Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany

    T. Bach

Authors
  1. Christopher Netsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Stoehrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Brüning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Gabuev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Bach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. R. W. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. J. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher Netsch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Netsch, C., Stoehrer, M., Brüning, M. et al. Safety and effectiveness of Thulium VapoEnucleation of the prostate (ThuVEP) in patients on anticoagulant therapy. World J Urol 32, 165–172 (2014). https://doi.org/10.1007/s00345-013-1093-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1093-4

Keywords

Search

Navigation